Nutrition and older Indigenous Australians: Service delivery implications in remote communities. A narrative review

An Alternative Nutrient Rich Food Index (NRF-ai) Incorporating Prevalence of Inadequate and Excessive Nutrient Intake

Most nutrient profiling models give equal weight to nutrients irrespective of their ubiquity in the food system. There is also a degree of arbitrariness about which nutrients are included. In this study, an alternative Nutrient Rich Food index was developed (NRF-ai, where ai denotes adequate intake) incorporating prevalence of inadequate and excessive nutrient intake among Australian adults. Weighting factors for individual nutrients were based on a distance-to-target method using data from the Australian Health Survey describing the proportion of the population with usual intake less than the Estimated Average Requirement defined by the Nutrient Reference Values for Australia and New Zealand. All nutrients for which data were available were included, avoiding judgements about which nutrients to include, although some nutrients received little weight. Separate models were developed for females and males and for selected age groups, reflecting differences in nutrient requirements and usual intake. Application of the new nutrient profiling models is demonstrated for selected dairy products and alternatives, protein-rich foods, and discretionary foods. This approach emphasises the need to identify foods that are rich in those specific nutrients for which intake is below recommended levels and can be used to address specific nutrient gaps in subgroups such as older adults. In addition, the new nutrient profiling model is used to explore other sustainability aspects, including affordability (NRF-ai per AUD) and ecoefficiency (NRF-ai/environmental impact score).

Food and nutrition programs for Aboriginal and Torres Strait Islander Australians: an overview of systematic reviews

Objective To provide an overview of previous reviews of programs that aimed to improve nutritional status or diet-related health outcomes for Aboriginal and Torres Strait Islander peoples, in order to determine what programs are effective and why. Methods A systematic search of databases and relevant websites was undertaken to identify reviews of nutrition interventions for Aboriginal and Torres Strait Islander Australians. Pairs of reviewers undertook study selection and data extraction and performed quality assessment using a validated tool. Results Twelve papers reporting 11 reviews were identified. Two reviews were rated high quality, three were rated medium and six were rated low quality. The reviews demonstrated that a positive effect on nutrition and chronic disease indicators can be a result of: 1) incorporating nutrition and breastfeeding advice into maternal and child health care services; and 2) multifaceted community nutrition programs. The evidence suggests that the most important factor determining the success of Aboriginal and Torres Strait Islander food and nutrition programs is community involvement in (and, ideally, control of) program development and implementation. Conclusions Community-directed food and nutrition programs, especially those with multiple components that address the underlying causes of nutrition issues, can be effective in improving nutrition-related outcomes. What is known about the topic? More effective action is urgently required in order to reduce the unacceptable health inequalities between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians. Food insecurity and nutrition-related chronic conditions are responsible for a large proportion of the ill health experienced by Australia’s First Peoples. What does this paper add? This narrative overview of 11 reviews published between 2005 and 2015 provides a synthesis of the current evidence for improving Aboriginal and Torres Strait Islander nutrition across the lifespan. The findings suggest that community-based and community-controlled programs, especially those with multiple components that address the underlying causes of nutrition issues, have the greatest potential to improve nutrition-related health outcomes. What are the implications for practitioners? Food and nutrition programs that are initiated and designed by local Aboriginal and Torres Strait Islander people are most likely to be effective. Nutrition and breastfeeding education and advice should be consistently incorporated into maternal and child healthcare services. Nutrition issues should be addressed through multifaceted approaches that address improving individual knowledge and skills, as well as strategies that increase access to nutritious food and provide a healthy food environment.